Progression-free survival (PFS) and cardiac-toxicity-adjusted-PFS (CTA-PFS) as predictors of overall survival (OS) in locally advanced non-small cell lung cancers (LA-NSCLC) treated with concurrent chemoradiation (CCRT): A secondary analysis of NRG Oncology RTOG 0617.

Authors

Chen Hu

Chen Hu

Johns Hopkins University, Baltimore, MD

Chen Hu , Mitchell Machtay , James J. Dignam , Rebecca Paulus , Jeffrey D Bradley

Organizations

Johns Hopkins University, Baltimore, MD, CASE Comprehensive Cancer Center, University Hospital of Cleveland Medical Center, Cleveland, OH, The University of Chicago, Chicago, IL, NRG Oncology Statistical and Data Management Center, Philadelphia, PA, Washington University School of Medicine in St. Louis, St. Louis, MO

Research Funding

NIH

Background: OS is the gold standard for LA-NSCLC with CCRT, with complex relationships among RT dosimetry, systemic therapies, cardiopulmonary toxicity, progression (PD) and OS of growing scientific and clinical interest. Methods: RTOG 0617 (NCT00533949) randomized standard (SD, 60 Gy) versus high-dose (HD, 74 Gy) CCRT +/- cetuximab from 11/07-06/11. This analysis includes 469 patients (pts) given ≥50 Gy. A PFS event was defined as the first occurrence of local, regional, distant PD or death w/o documented PD. A CTA-PFS event was the first occurrence of grade 2+ treatment-related cardiac toxicity event or a PFS event. Landmark analyses at 6mo and 12mo were used to minimize the immortal time bias. Cox model with PD or CT/PD as a time-dependent covariate was used to evaluate their predictive roles. Median f/u time for surviving pts was 5.1 years. Results: As reported, pts treated with HD had significantly lower OS rates (HR = 1.28, 95%CI: 1.04-1.58, p = 0.018) and CTA-PFS rates (HR = 1.24, 95%CI: 1.02-1.51, p = 0.035), and marginally lower PFS rates (HR = 1.21, 95%CI: 0.99-1.47, p = 0.06) than pts treated with SD. Median survival time (MST) among pts having PD within 6mo versus not were 13.4mo (95%CI: 10.0-19.0) and 30.7mo (95%CI: 28.0-37.0) (p < 0.001). MST for pts having PD within 12mo versus not were 20.6mo (95%CI: 18.8-25.0) and 60mo (95%CI: 47.6-74.5)(p < 0.001). Results are similar when using CTA-PFS with 6mo or 12mo cutoff (p < 0.001). RT dose was no longer significantly associated with OS (p = 0.08 or p = 0.15) when PD or CT/PD was included in multivariable analysis (p < 0.001), suggesting OS differences in HD/SD may be partially captured by PFS or CTA-PFS. Conclusions: RTOG 0617 survival results suggest that PFS (or CTA-PFS) status at 6mo or 12mo predicts long-term OS, and may potentially be considered as a surrogate endpoint of OS in clinical trials. Pts who were progression-free at 12mo had a MST of 5 years. Further validation on external datasets and in the modern era of immunotherapy are needed.

Disclaimer

This material on this page is ©2024 American Society of Clinical Oncology, all rights reserved. Licensing available upon request. For more information, please contact licensing@asco.org

Abstract Details

Meeting

2018 ASCO Annual Meeting

Session Type

Poster Session

Session Title

Lung Cancer—Non-Small Cell Local-Regional/Small Cell/Other Thoracic Cancers

Track

Lung Cancer

Sub Track

Local-Regional Non–Small Cell Lung Cancer

Citation

J Clin Oncol 36, 2018 (suppl; abstr 8539)

DOI

10.1200/JCO.2018.36.15_suppl.8539

Abstract #

8539

Poster Bd #

145

Abstract Disclosures